Blakey, Shannon M, Halverson, Tate F, Evans, Mariah K et al. · Journal of psychiatric research · 2021 · DOI
This study looked at whether avoiding uncomfortable thoughts and feelings is connected to health problems in Gulf War veterans. Researchers surveyed over 450 veterans and found that those who tend to avoid dealing with difficult emotions were more likely to have PTSD, depression, chronic fatigue syndrome, fibromyalgia, and digestive problems—even after accounting for combat exposure and chemical exposure during the war.
This work is relevant to ME/CFS because chronic fatigue syndrome was among the conditions significantly associated with experiential avoidance in this veteran population. The findings suggest that psychological factors like emotion avoidance may contribute to symptom burden in conditions with overlapping presentations, and that targeting these modifiable factors could be part of comprehensive care for ME/CFS patients.
This cross-sectional design establishes association, not causation—we cannot determine whether experiential avoidance causes these illnesses or whether having chronic illnesses leads people to develop avoidance coping. The study was conducted in Gulf War veterans with specific environmental exposures (NBC agents), so findings may not directly generalize to other ME/CFS populations. The use of self-report measures introduces potential recall bias and cannot rule out unmeasured confounding variables.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Blakey, Shannon M, Halverson, Tate F, Evans, Mariah K, Patel, Tapan A, Hair, Lauren P, Meyer, Eric C, et al. (2021). Experiential avoidance is associated with medical and mental health diagnoses in a national sample of deployed Gulf War veterans.. Journal of psychiatric research. https://doi.org/10.1016/j.jpsychires.2021.07.033
BibTeX
@article{mecfsatlas-blakey-2021-experiential-avoidance,
author = {Blakey, Shannon M and Halverson, Tate F and Evans, Mariah K and Patel, Tapan A and Hair, Lauren P and Meyer, Eric C and DeBeer, Bryann B and Beckham, Jean C and Pugh, Mary J and Calhoun, Patrick S and Kimbrel, Nathan A},
title = {Experiential avoidance is associated with medical and mental health diagnoses in a national sample of deployed Gulf War veterans.},
journal = {Journal of psychiatric research},
year = {2021},
doi = {10.1016/j.jpsychires.2021.07.033},
note = {PubMed: 34314990},
url = {https://www.mecfsatlas.com/evidence/blakey-2021-experiential-avoidance},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-27. https://www.mecfsatlas.com/evidence/blakey-2021-experiential-avoidance
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